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Urinary Incontinence

Stress Incontinence

There are many options for managing stress incontinence.

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Information on Stress Incontinence

Stress incontinence is extremely common. Approximately 60 percent of women experience some leakage with activity at some time in their lives. However, stress incontinence is not uncommon in women in their 20s and 30s. Risk factors for stress incontinence include pregnancy and childbirth, repetitive heavy lifting, constipation, a chronic cough, and even a family history of stress incontinence.

Stress incontinence is caused by a weak urethra. The urethra is the tube through which urine leaves the bladder and then leaves your body. The function of the urethra is to stay closed against the bladder when at rest and during activities such as exercising and coughing. When you have stress incontinence, the urethra is not strong enough to stay closed against such forces.

A weak urethra can be the result of loss of support underneath the urethra, or as a result of a weakness in the sphincter muscles of the urethra—or both. Additionally, stress incontinence can result from weakening or loss of effectiveness of the pelvic floor muscles (also known as the Kegel muscles).

What are the Symptoms of Stress Incontinence?

Stress incontinence is the unwanted loss of urine that is associated with a variety of activities such as:

Coughing.
Laughing.
Sneezing.
Running or any exercise.
Jumping.
Sex.
Changing positions.

The severity of leakage can vary greatly. For some women it can require a severe stress such as running a marathon or a powerful sneeze. In others, the simple motion of rolling over in bed can cause the loss of urine. There is no specific amount of leakage that is considered a cutoff for treatment. The problem is severe enough to be treated when you want it treated, whether it is 20 times daily or 20 times yearly.

How is Stress Incontinence Treated?

There are many options for managing stress incontinence. They include:

Doing nothing. Stress incontinence is not an emergency. Although leakage can be inconvenient and embarrassing, the decision to treat it is entirely yours. There are no long-term complications of leakage that would shorten your life.
Medication. Although several medications have been studied for stress incontinence, currently there are no medications that are approved by the FDA for treating stress incontinence.
Pelvic floor strengthening. In mild cases, strengthening your pelvic floor muscles can correct mild incontinence and significantly improve more severe incontinence. Proper instruction is important to learn the correct technique in performing these exercises to maximize results. Our center can help provide that instruction. Recent studies have shown that 80 percent of women can improve with pelvic floor strengthening.
Pessary. These are plastic devices that are placed in the vagina while you are in the office. The pessary acts as a brace to stabilize the urethra. Although the effectiveness of pessaries for stress incontinence is limited, it remains a viable option for stress incontinence.
Barriers/devices. A variety of inserts and barriers can be used to prevent incontinence. Some of these devices can be placed in the urethra itself to act like a cork, while others are placed on the outside of the urethra as a cup to catch the urine. These devices do not correct the problem but can be used to prevent urine from leaking into your clothes.
Surgery. There are many different procedures to correct incontinence. The most common procedure is one called a sling. A sling is essentially a hammock that is placed under the urethra to provide a firm backboard and support for the urethra. Although a variety of different slings is available, the most common slings are relatively quick (30 minutes) outpatient procedures that have been available since the late 1990s. The sling can have success rates as high as 95 percent, depending on the severity of your incontinence and the technique used. Slings are durable; some studies report persistent success as long as 11 years. There is a wide variety of sling materials used, from natural to synthetic. the most common sling used is made of a material called polypropylene. This is a permanent material that has been used as a suture for decades. It is woven into a mesh or net that is 1/3 inch wide. When prepared properly, the material is very well tolerated with rare rejection or infection. It is placed via a vaginal incision. There is minimal post-operative discomfort.
Urethral injections. This is a minimally invasive treatment in which the surgeon injects a material around the urethral tube to “bulk” it and allow it to close more completely. The oldest bulking agent is collagen, which has been used in other parts of the body as well with success. Alternatively, carbon beads and foam-like products can be used. Bulking is useful in a small subset of patients with stress incontinence. Injections are not as successful as slings, but injections have other advantages. They can often be performed with a local anesthetic, thus avoiding the need to go to sleep. Bulking is an outpatient procedure that involves no incisions, but merely the introduction of the material via a needle around the urethra. It only takes a few minutes and has little to no post-operative discomfort.